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What is the optimal initial dose of epinephrine during neonatal resuscitation in the delivery room?

Journal of Perinatology volume 41, pages 1769–1773 (2021)Cite this article

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Abstract

The neonatal resuscitation program recommends a wide dose range of epinephrine for newborns who receive chest compressions (endotracheal tube [ET] dose of 0.05–0.1 mg/kg or intravenous [IV] dose of 0.01–0.03 mg/kg), which presents a challenge to neonatal care providers when attempting to determine the optimal initial dose. Dosing errors are common when preparing epinephrine for neonatal resuscitation. Based on animal data, we suggest preparing 0.1 mg/kg or 1 ml/kg of 1 mg/10 ml epinephrine in a 5 ml syringe for ET administration. For IV epinephrine, we suggest preparing an initial dose of 0.02 mg/kg or 0.2 ml/kg of 1 mg/10 ml epinephrine in a 1 ml syringe. A dose of 0.02 mg/kg enables use of a 1 ml syringe for a wide range of birth weights from 500 g to 5 kg. The use of a color-coded syringe may decrease errors in dose preparation.

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Fig. 1: Suggested initial endotracheal and intravenous (IV) epinephrine doses using 5 ml and 1 ml syringes, respectively.

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Funding

The work has been supported by American Academy of Pediatrics/Neonatal Resuscitation Program grant (SL), NIH grants HD096299 (PV) and HD072929 (SL).

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The AAP/NRP and NIH had no role in the design and conduct of the study.

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Authors and Affiliations

  1. Department of Pediatrics, University of California, Davis, Sacramento, CA, USA

    Payam Vali, Deepika Sankaran & Satyan Lakshminrusimha

  2. Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA

    Gary M. Weiner

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  1. Payam Vali
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  2. Gary M. Weiner
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  3. Deepika Sankaran
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  4. Satyan Lakshminrusimha
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Contributions

Dr PV drafted the initial paper, and reviewed and revised it. Drs GMW, DS and SL reviewed and revised the paper. All authors approve the final paper as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Payam Vali.

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Conflict of interest

The authors have no competing interest to disclose. SL is a member of the American Academy of Pediatrics, Neonatal Resuscitation Program (AAP/NRP) Steering Committee. GMW is editor of the AAP/NRP Textbook of Neonatal Resuscitation 7th edition and member of the International Liaison Committee on Resuscitation (ILCOR) Neonatal Task Force. The views expressed in this commentary are individual opinion of the authors and do not reflect the view of AAP/NRP or ILCOR.

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Vali, P., Weiner, G.M., Sankaran, D. et al. What is the optimal initial dose of epinephrine during neonatal resuscitation in the delivery room?. J Perinatol 41, 1769–1773 (2021). https://doi.org/10.1038/s41372-021-01032-7

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